Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s

• Published in: Infectious Diseases in Obstetrics and Gynecology 2004-06, Vol.2004 (2), p.99-108
• Main Authors: Per-Anders Mårdh, Jolanta Wågström, Maria Landgren, Jan Holmén
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antibiotics; Antifungal Agents - administration & dosage; Azoles - administration & dosage; Candidiasis; Candidiasis, Vulvovaginal - diagnosis; Candidiasis, Vulvovaginal - drug therapy; Candidiasis, Vulvovaginal - epidemiology; Clinical Medicine; Databases as Topic; Demography; Drug; Drug Prescriptions; Drug therapy; Drugs; Epidemiology; Female; Fungi; Humans; Infections; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Non-Prescription; Nonprescription Drugs; Obstetrics, Gynecology and Reproductive Medicine; Pathogens; Pharmacies - trends; Prescription drugs; Prescriptions; Recurrence; Reproduktionsmedicin och gynekologi; Rural Population; Self Medication; Sexual Behavior; Sweden - epidemiology; Urban Population; Vulvovaginal: diagnosis; Vulvovaginal: drug therapy; Vulvovaginal: epidemiology
• ISSN: 1064-7449; 1098-0997
• DOI: 10.1080/10647440400003972

Background: The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. Objectives: To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. Methods: Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990-1999. The size of the female population in the county is approximately half a million. Results: The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid-1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for selfselection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. Conclusion: The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.